Director, Medical Policy

Description

We are changing the standard of care for millions of untreated sufferers of ENT conditions. We improve patient access to life-changing relief through safe, practical, and effective innovation that changes how and where patients are served. Aerin differentiates itself with our commitment to providing straightforward and clinically proven products so that ENTs and their patients can make treatment decisions together without limits.

At Aerin Medical our values show up as: always seeking the collective good, holding ourselves and each other accountable, showing respect with compassion, creation and innovation and being all in.

As the Director, Medical Policy, you will be an essential part of our mission-driven team, dedicated to transforming the lives of those with untreated ENT conditions. Your role will involve contributing directly to our commitment to innovation and improved patient care.

The Director of Medical Policy will report to the VP of Medical Policy and Reimbursement, responsible for the deployment of payer coverage initiatives for Aerin Medical products. Focused on regional payer coverage, building key relationships, and collaborating with ENT state societies, the Director will engage influential leaders and key investigators to drive impactful medical policy strategies. With a robust understanding of CMS’ rule-making and future rate-setting methodologies, the Director will collaborate with cross-functional teams and external consultants to address evidence gaps that may impact payer policy decisions and coverage. This role will require a strong understanding of billing, coding, and reimbursement methodologies for all places of service, as well as the ability to interpret payer policies and initiatives required for payers to consider a favorable coverage policy for a new procedure code.

MAJOR DUTIES AND RESPONSIBILITIES

• Focus on medical policy and coverage strategies. Schedule meetings with payers to address non-coverage policies and collaborate closely with Key Opinion Leaders (KOLs)
• Comprehensive knowledge of the US payer landscape, encompassing the CMS rule-making process. This includes a proficient understanding of interpreting rate files, addendums, cost statistic files, and billing methodologies relevant to future rate setting in the facility setting
• Analyze market access trends, changes in health policy, and health technology assessments. Map reimbursement requirements specific to each payer type for Aerin Medical products, offering proactive recommendations on targeted payers and strategic approaches
• Understand and prioritize the most relevant market access stakeholders that will impact medical policy, including but not limited to medical directors, governmental bodies, industry associations, and professional medical societies
• Work closely with the VP of Medical Policy and Reimbursement to develop customer-facing materials that communicate Aerin’s value proposition, considering the specific needs of payers and reimbursement-related stakeholders, and identify mutually beneficial partnering opportunities
• Support the field market access team in identifying opportunities to assist customers with billing and coding needs, and provide resources to overcome access barriers
• Assess individual customer reimbursement landscapes and educate customers on opportunities to engage payers to advocate for coverage

Requirements

EDUCATION

• Bachelor’s degree required
• Billing and coding certifications a plus

EXPERIENCE REQUIRED

• 8 years experience in market access and experience working with commercial payers on coverage initiatives
• Track record of using product attributes, clinical evidence, and health economic considerations to generate compelling messages that influence coverage policy decisions
• Broad knowledge of government and private payer reimbursement
• Existing network to local market access stakeholders
• Ability to analyze information and assess risk potential
• Experience in ENT market is a plus

TECHNICAL SKILLS/TRAINING REQUIRED

• Ability to assess impact of payer policies
• Ability to develop impactful strategies & action plans to mitigate reimbursement challenges
• Skills and acumen to build collaborative relationships with relevant decision makers and key opinion leaders
• Ability to execute and impact on reimbursement decisions
• Strong written and verbal communication skills required
• PowerPoint/ Excel/ Word
• Travel
• This role requires up to 60% domestic travel

BENEFITS AND PERKS:

Our culture is rooted in our core values every day, in everything we do.

Our benefits focus on the 5 dimensions of wellbeing: physical, financial, emotional, career and community. Physical benefits include Medical – PPO & HSA with co-contribution, Dental, Vision, Accident Insurance, Critical Illness, Hospital Indemnity, and onsite Tonal & Peloton. Financial benefits include HSA/FSA, 401k, Lifestyle Spending Account, Long Term Disability, Life Insurance, a monthly stipend to cover phone and tech costs, employee discounts, and weekly office lunches. Emotional benefits include Employee Assistance Program, 5 free counseling sessions per issue per year, 80 hours sick leave, 13 holidays, and flexible vacation (exempt employees). Career and Learning & Development opportunities with Aerin led leadership trainings. Community initiatives which include Aerin “give back” week, family days as well as Aerin holiday giving.